013422337-4-14-2023-52-CC-RHAR-CQVQU4-20230414122806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422337
Report Date: 04/14/2023
Date Signed: 04/14/2023 12:28:16 PM

Document Has Been Signed on 04/14/2023 12:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SHAH, HINA		FACILITY NUMBER:	013422337
ADMINISTRATOR:	SHAH, HINA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(510) 377-2622
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 7	CENSUS: 6	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Hina Shah		TIME COMPLETED:	12:30 PM

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On April 14, 2023 at approximately 9:50am Licensing Program Analyst (LPA) Russ Haderer arrived for an unannounced 1-year annual inspection. Living in the home is the licensee, her fingerprint cleared and TB tested husband. Present today is the licensee’s fingerprint and TB tested husband Tejas Shah, her fingerprint and TB tested helper Sarita Verma, and 6 children in care (3 infants, 2 two-years old; 1 three-years-old). The facility is in ratio today. The hours of operation remain 9:00am to 6:00pm.

The facility is a two-story home with owned by the licensee with a living room; dining room; kitchen; family room; attached 2-car garage, side and back yard areas. The home has heating and ventilation for safety and comfort. Fire clearance for a capacity of 14 was approved by the Fremont Fire Department on 05/18/2022; Licensee reminded to abide by the conditions of the fire clearance (second floor and garage is off limits to children). Pull down fire alarm has been installed in the living room near the front door. Per the licensee, the ISOLATION AREA will be in the in the family room (day care area), away from the other children in care.

On-limit-areas include: Downstairs areas including the entry way into the childcare area and hallway to the ½ bathroom; family room (day care area); kitchen and 1/2 bathroom. Licensee was reminded that other than wipes or things used for the children in the on limits children’s bathroom, they need to be empty of most all items (or locked up) such as cleaning products etc. The kitchen has appropriate latches for safety mounted in all cupboards and drawers within the children's reach. There were no hazardous items found in any drawers or cupboards.

Off-limit-areas include: Living room, dining room, downstairs bedroom, laundry room and 2-car garage. The entire upstairs is also off limits. The downstairs off-limit areas are made inaccessible by visual supervision, a sliding pocket door from the kitchen into the dining room and a gate in the hallway blocking access to off limits areas. There are child proof door knob covers to the laundry room that also leads to the 2-car garage The off-limit areas will be inaccessible by closed and/or locked doors, child gates and/or by child supervision.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHAH, HINA	FACILITY NUMBER: 013422337
	VISIT DATE: 04/14/2023

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Licensee has ample age-appropriate toys and learning materials inside and outside that were observed to be safe and in good condition. Per licensee, there are no firearms in the home. Toxins, medicines, and hazardous items were inaccessible during today's inspection.

There is a screened fireplace in the family room (day care area) also blocked by furniture. The home has a fully charged 2A10BC fire extinguisher locate on the kitchen wall. There are smoke alarms and a carbon monoxide detector (all tested and functioning), and a working telephone. Fire Drills are conducted monthly, the last drill was completed on 4/05/2023.

The licensee CPR and First Aid certificate are current and expires on 7/10/2023; Mandated Reporter training is not available in licensee’s native language and therefore the requirement is waived until it becomes available. Assistant completed Mandated Reporter on 1/27/2022 and will renew in January 2024. All adults living and working in the home are in compliance with all other immunization laws which pertains to day care providers.

LPA reminded licensee of the following: CPR/First Aid is to be renewed every two years. Baby bouncers & drop-down cribs are not allowed at the day-care facility. LPA did not observe any bodies of water hazardous materials, or toxins accessible to children on the premises during the inspection.

Children’s files were reviewed. A copy of the children’s roster was available, and a photocopy taken by the LPA for the office file. All files were complete and well organized. The licensee owns the property, does not carry liability insurance. All LIC 282 forms Notice of no Liability Insurance signed and dated in each child’s file.

Licensee’s new assistant has fingerprint clearance, however, was not associated to the facility. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. LPA provided a copy of the LIC9182 Criminal Background Clearance Transfer Request form to be used for any future assistants.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SHAH, HINA	FACILITY NUMBER: 013422337
	VISIT DATE: 04/14/2023

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no deficiencies issued today.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Hina Shah.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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